title: Treatment of chronic deep vein thrombosis using ultrasound accelerated catheter-directed thrombolysis.
abstract: OBJECTIVE
  To evaluate the feasibility, efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the delayed treatment of lower extremity deep venous thrombosis (DVT).
  
  
  METHODS
  Twelve patients with unilateral iliofemoral or femoropopliteal DVT (mean symptom duration 92 ± 44 days) were prospectively investigated.
  
  
  METHODS
  UACDT was performed using recombinant human tissue plasminogen activator delivered using the EKOS EkoSonic system. Stents were deployed if indicated by post-procedure venography. Follow-up comprised weekly duplex ultrasound for 1 month and monthly thereafter.
  
  
  RESULTS
  Successful thrombolysis occurred in 11/12 limbs (92%; complete 6/12, partial 5/12) after a mean infusion time of 26 ± 7 hours. 2/12 patients required angioplasty and stent insertion. At a mean follow-up of 9 (6-15) months, 10/11 (91%) veins were patent whereas 1/11 re-occluded at 2 months (patient with protein-C deficiency). 2/11 limbs developed symptoms/signs of post-thrombotic syndrome and 3/11 had developed deep vein reflux (duplex ultrasound). 2/12 patients experienced peri-catheter bleeding but no major hemorrhage or symptomatic pulmonary embolism occurred.
  
  
  CONCLUSIONS
  This preliminary evidence suggests that UACDT may be a safe and effective option for the delayed treatment of lower limb DVT.
authors.affiliation: Department of Cardiovascular Surgery, Memorial Atasehir Hospital, Istanbul, Turkey. mdumantepe@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Dumantepe
authors.forename: I A
authors.initials: IA
authors.lastname: Tarhan
authors.forename: A
authors.initials: A
authors.lastname: Ozler
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D002406:Catheterization, Peripheral; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011183:Postoperative Complications; D011446:Prospective Studies; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Catheter-directed thrombolysis; Chronic deep vein thrombosis; Post-thrombotic syndrome; Ultrasound